Prenatal Care

Important Prenatal Care Reminders

OK, now that you’ve calmed down from the initial excitement, searched the Internet for pregnancy information and made a down payment on a new maternity wardrobe, it’s time to focus on the most important thing here (and no, it’s not the paint color for the nursery): It’s your health and the baby’s health.

Your first assignment: Pick up the phone and call your doctor, nurse practitioner or midwife–whomever you plan to see throughout your pregnancy and delivery–and make an appointment. It’s time to begin prenatal care.

Meeting with a health care professional early on (even before you get pregnant if you are planning to conceive) is important for all women, but especially important if you have any medical conditions or family health problems that could put you or your baby at risk.

Who’s Who?

Here is a brief overview of the professionals who may be involved in your prenatal care and, in some instances, delivery.

Obstetrician (OB/GYN)

Look for a physician who is board-certified in obstetrics/gynecology. That means your doctor completed four years of medical school and four years of residency and passed a tough exam. Obstetricians are also trained surgeons, able to perform a cesarean section if necessary. Make sure the doctor you choose has privileges at the hospital or birthing center at which you plan to deliver. Some obstetricians specialize in high-risk pregnancies.

Best for

Women who are most comfortable with physician care; those who have health problems, previous pregnancy–related complications or the risk of problems with this pregnancy.

Family physician

Family physicians specialize in treating the entire family, from newborns to the elderly. They complete a three–year residency after graduating from medical school and are trained in prenatal care and delivery. Make sure your doctor is board certified in family medicine.

Best for

Women who are most comfortable with physician care and who expect a low-risk pregnancy and delivery.

Midwife

Midwives typically care for women with low-risk pregnancies. They can provide prenatal care and deliver babies, usually in hospitals or birthing centers, although some do home deliveries. They offer flexible, individualized care with as little medical intervention as possible. Look for a midwife certified by the American College of Nurse Midwives. They must graduate from a nationally accredited education program, pass a rigorous national certification exam and be licensed to practice in their state.

Best for

Women with no medical problems who expect to have a healthy pregnancy and delivery and prefer as little medical intervention as possible.

Doula

Doulas are specially trained individuals (usually women) who help care for the emotional needs of women during childbirth. Postpartum doulas help families transition into their new roles in the days and weeks after giving birth.

Best for

Women who want additional support in the delivery room.

Lactation consultant

Lactation consultants are specially trained to help women with breastfeeding issues. Most are nurses. They work in hospitals, pediatric offices, public health clinics and private practice.

Best for

Women who plan to breastfeed.

The First Visit and Beyond

In a normal pregnancy, you will see your health care professional every month until about the sixth month; then every two weeks during the seventh and eighth months, and then weekly until labor begins.

During the first visit, your health care professional will take a full health history, including a history of any previous pregnancies. You will also receive a full physical exam, including a pelvic exam and Pap test in most cases, and will be weighed and measured and have your blood pressure taken. Your health care provider should also test for any sexually transmitted infections and diseases. You will get a due date, officially called the "estimated date of delivery," typically 266 days from the first day of your last period if you have regular menstrual cycles. Otherwise it is customary to assign the due date based on an ultrasound.

During every future visit, you will be weighed, have your belly measured and blood pressure taken, have your urine tested for protein or sugar (signs of potential complications) and, most exciting, hear your baby’s heart beat.

Prenatal Tests

Near the end of your first trimester and early in the second trimester, your health care professional will talk with you about a variety of prenatal tests to assess the health of the fetus. It’s up to you which ones you have done and what you decide to do about the results. The most common prenatal tests and the timing are outlined in the chart below, listed in the order they may be given during your pregnancy. You may not need all of these tests. For example, some tests may only be recommended if you are 35 or older or have other risk factors for chromosomal abnormalities.

Common Prenatal Screening Tests

Test

What is it?

When/Where?

Genetic screening

If you have a family history of inherited diseases such as Tay-Sachs or thalassemia, consider genetic counseling to assess your risk of having a child with the disease. It is standard to offer all couples screening for cystic fibrosis. Some ethnic backgrounds may predispose you to carrying genetic disorders.

Ideally, should be performed before conception, but may be done early in the pregnancy. The screening begins with a session with a genetic counselor and may involve some blood tests.

Noninvasive prenatal testing (NIPT)

Placental cells are removed and tested for chromosomal and genetic disorders. May be recommended for women 35 and older and others at risk for certain disorders. It has a slightly higher risk of miscarriage than amniocentesis, but some women prefer it because it can be done earlier. Discuss the risks and benefits with your health care provider.

Any time after week 8 of pregnancy. Performed as a lab procedure. Currently available to most pregnant women, but generally used for high-risk pregnancies, including women 35 or older. Although it may help avoid other riskier tests, if an abnormality is detected, invasive testing will be suggested.

Chorionic villus sampling (CVS)

Placental cells are removed and tested for chromosomal and genetic disorders. May be recommended for women 35 and older and others at risk for certain disorders. It has a slightly higher risk of miscarriage than amniocentesis, but some women prefer it because it can be done earlier. Discuss the risks and benefits with your health care provider.

Involves an ultrasound scan and blood testing to help predict the risk of chromosomal abnormalities in the baby, such as Down syndrome. Allows women to get more information about the health of their babies without undergoing more invasive tests.

10-14 weeks. Typically performed in the office or in a diagnostic center.

Blood tests detect 4-5 substances in your blood that come from the baby that could be a sign of a birth defect, such as neural tube defects and trisomies 21 and 18. The test is a screening tool to identify women who are at increased risk for certain birth defects and may need further tests such as amniocentesis.

15-18 weeks for all pregnant women. Typically performed as an in-office procedure.

Amniocentesis

A needle is inserted into the amniotic sac and a bit of the amniotic fluid is removed and examined. This test can provide information on various chromosomal and genetic abnormalities, including Down syndrome and neural tube defects. Usually recommended for women 35 and older and others at risk for certain disorders. Discuss the risks and benefits with your health care provider.

After 15 weeks. Performed as an in-office procedure.

Ultrasound

Sound waves are used to help identify gestational age, detect multiple pregnancies and identify any structural anomalies.

18-20 weeks for most women, though you may have more than one throughout pregnancy. Typically performed in the office or in a diagnostic center.

Blood sugar screening (also known as oral glucose challenge test)

Measures your body’s response to sugar (glucose) and is used to diagnose gestational diabetes. A test called the glucose challenge test is now considered a standard test for the early part of the third trimester. No preparation or fasting is necessary for a glucose challenge test. During the test, the mother drinks a sweet glucose liquid and then has her blood drawn one hour afterward, because glucose levels usually peak within one hour. If the glucose challenge test is positive, you will have to undergo a longer test called a glucose tolerance test. Before the glucose tolerance test, you will need to fast for 14 hours. Then you will drink a larger glucose liquid beverage, and your blood will be drawn once an hour for three hours.

Between weeks 24-28. Performed in the office.

Fetal heart rate monitoring

Test uses a device strapped to your abdomen and results are recorded on a tracing. A non-stress test is normally performed first, and a contraction stress test may be recommended if you have an abnormal non-stress test. Both enable health care professionals to monitor your baby’s heart rate and check his or her well-being before delivery.

Last 10-12 weeks of pregnancy; may be performed earlier if a problem arises, such as high blood pressure in you, or if you don’t feel the baby moving. Performed in the office.

Ultrasound: Getting the Best Picture

There are several types of ultrasounds. All work basically the same–they use a noninvasive transducer wand or probe that sends out high-frequency sound waves, which bounce off internal organs, fluid and tissue to create an image. Some ultrasound machines create more detailed 3-D and 4-D pictures; these machines are usually used in high-risk centers to look for suspected problems. There are two basic types of ultrasounds, and the type of ultrasound you will receive depend on how far along you are in your pregnancy and what your health care practitioner wants to see:

Transvaginal scans

An ultrasound wand is inserted into the vagina to generate the images. This form is typically used in early pregnancy to provide detailed images of the uterus and ovaries.

Standard ultrasound

This is the traditional ultrasound most women have sometime in their second trimester. The ultrasound wand is moved over the belly to create an image.

During an ultrasound procedure, the technician may also use other types of ultrasound to look at more specific areas in the fetus. For example, a Doppler ultrasound evaluates blood as it moves through the vessels, and a fetal echocardiography uses sound impulses to assess fetal heart function.

Who and When to Tell

Although you may want to send an e-mail to everyone in your address book, post to your Facebook account and shout your pregnancy from the proverbial rooftops, we urge you to relax and take a deep breath.

The first three months are the most common time for miscarriage; so give the baby time to get settled. Plus, you need time to adjust to the news, to discuss options with your partner (Keep working? Work part-time? Quit your job?) and decide how to break the news to your employer, if you’re employed.

If you work for a company that employs 50 or more people for at least 20 weeks a year, you are covered by the Family and Medical Leave Act. The act requires that your employer provide up to 12 weeks of unpaid leave during any 12-month period for the birth and care of a newborn child. When you return, you are entitled to your same job or the equivalent.

In addition, most states require that employers offer the same disability leave (and pay) to pregnant women as to employees with other medical conditions that interfere with their ability to work. Thus, many women find that their first six weeks of leave are often paid.

However, every company is different. The only way to know what goes on in your company is to talk to your human resource department or your manager/employer–after your first trimester.

Preparing for "The Talk"

Make a list of questions regarding benefits and maternity leave to discuss with your employer after your first trimester. Also, develop a plan for how your job will be handled while you’re out on maternity leave and for your post-pregnancy employment. The more on top of things you are, the better things will go with your manager/employer.

First Trimester Issue

So how are you feeling? If you’re like most women, the answer is exhausted and nauseous. Let’s deal with the fatigue first. Do you have any idea what your body is doing right now? It is building a home–the placenta, that is–that can nourish and protect your baby for the next nine months. This is really hard work. It takes a lot of energy–your energy. So stop being superwoman for once and listen to what your body is telling you. That means:

Napping on the weekends and when you get home from work

Slowing down at work if possible

Putting your feet up as much as possible

Turning over housework, cooking, errands, etc., to your partner, friend or a professional agency–or just letting things go for a while

Don’t worry; in your second and much of your third trimesters, you’ll have energy to burn.

Now, about that nausea: They call it morning sickness, but for many women it lasts all day. You may never throw up–just feel like you’re occasionally (or continually) seasick–or you may throw up every morning as soon as your feet hit the floor. Don’t worry. This is normal. There is even some evidence that the nausea is nature’s way of protecting the baby from potentially harmful foods.

Most morning sickness disappears by the end of the first trimester. Until then:

Eat small meals throughout the day so you’re never too full or too hungry